The present invention relates in general to a swallowing and speech therapeutic device for strengthening the lingual musculature through the use of a water-filled tube with pressurized bulbs on each end. The bulb is placed in the mouth and pressed against the hard palate with the dorsum of the tongue. The compression of the pressurized bulb exercises the tongue in an upward movement as is performed by the tongue during the act of swallowing and for speaking.
Speech and swallowing disorders can result from a number of causes including: stroke, brain disease, brain injury, developmental disorders, spinal cord injury, multiple sclerosis, amyotrophic later sclerosis (ALS), muscular dystrophy, Alzheimer's disease, Huntington's disease, Parkinson's disease, cerebral palsy, autism, and cleft palate. Loss of tongue strength as a result of these etiologies can lead to swallowing disorders and impaired speech intelligibility. Head and neck cancers of the throat or mouth with or without concomitant radiation can result in impaired swallow or speech. Disorders of the swallow (dysphagia) can lead to lengthy or repetitive hospitalizations, a number of resulting illnesses such as pneumonia and a loss of the enjoyment of eating. Communication loss as a result of tongue weakness leads to dependency on others for care and emotional decline.
In addition to medical causes, tongue strength can also decline in the elderly. This age related tongue weakening can result in physical disease and reduced pleasure in eating
Dysphagia treatment may involve modification of the patient's diet to foods or liquid consistencies that are easier to swallow. Swallowing therapy incorporates exercises for strengthening and coordinating the swallowing muscles and stimulating the nerves that trigger the swallow to respond. The size, strength and power of the tongue are important components to safe swallowing of liquids as well as solid food.
Dysarthria is the loss of speech clarity due to weakness of the oral musculature.
Speech pathologists use speech sound drills and motor exercises to increase the strength of the tongue as well as the lips and palate. More specifically, exercises to increase the strength of the tongue, the range of movement and the speed of tongue movement are a large focus in this type of care.
Equipment and devices are available to exercise the tongue in the therapy setting but very few are available for patients to purchase for home exercise. An example of a tongue exercise clinical tool is the Iowa Oral Proficiency Instrument (IOPI), which is described in the article, Swallowing and Tongue Function Following Treatment For Oral and Oropharyngeal Cancer, by Lazarus, et al. 2000, Journal of Speech, Language and Hearing Research 43, 1011. The IOPI uses an air-filled bulb, which is connected by a hose to a manometer instrument. The free moving small balloon is placed on the patient's tongue and pressed by the patient against the hard palate. The instrument provides a digital quantitative score of tongue strength in kilopascals. It has a light display that can be set manually to a desired level and lights up as the air-pressured bulb is pressed. This light acts as visual feedback to motivate the patient to press with greater effort. The IOPI can be used to diagnostically measure tongue strength and to exercise the tongue but due to its cost it can only be used in direct care. Research has clearly supported the use of this device with such populations as the elderly who often experience age related tongue weakness leading to increased difficulty eating or drinking.
A similar oral exercise system used for swallowing and speech rehabilitation was described by Hewitt et al. in the article, Standardized Instrument for Lingual Pressure Measure, 2008, Dysphagia 23: 16-25. This tool is the Madison Oral Strengthening Therapeutic device (MOST). As presented, this device has a multi-sensor custom molded mouthpiece, which is connected to an electronic annunciator. The custom molded mouthpiece is placed in the patient's mouth and measures contact pressures between the tongue and the hard palate. As with the IOPI, MOST's cost preclude purchase or use by patients outside of research and direct care.
U.S. Pat. No. 6,050,961 reveals a system designed to address tongue weakness in the treatment of dysarthria and dysphagia. This tool utilizes a pair of planks and a pneumatic bulb positioned between the planks. The bulb is coupled to a meter that displays the strength and the duration of the force applied to the pneumatic bulb by the patient's tongue. Although this system provides feedback to the user, it is relatively complex, expensive, of limited durability as the bulb weakens or punctures and is not suited for regular use by the patient as part of an exercise regime.
The National Institutes of Health described a device to measure tongue strength termed the APLSILT. This instrument used a disposable tongue depressor mounted on a load cell held by a mechanism on an adjustable table. Only the tongue depressor was placed within the patient's mouth with the remaining portions of the mechanism being outside of the patient's mouth and supported by the table. This tool's availability is unknown but the complexity of this load cell device precludes its home use.
Robbins et al. U.S. Pat. Nos. 7,238,145 and 7,438,667 B2 describes an oral-lever resistance exercise device, which was portable and simple in design. The device patented consists of two levers that fit in the mouth and are connected by a spring or pin joint. During exercise, the user compresses the levers between the tongue and hard palate. Springs or circular rubber belts similar to O-rings provide adjustable resistance but the hard palate adaptor must be custom-molded.
U.S. Pat. No. 8,376,912 B1 by Dedvukaj 2013 describes a facial muscle exercise ball-like device and method for toning the facial and/or jaw muscles. The device is placed in the mouth and held in place by the teeth. The resistance afforded by this device is available in various psi strengths. The resistance portion of the device is outside of the mouth. This device is designed for the face and the jaw. Swallowing with the mouth open is not recommended and strengthening of the tongue is not the goal with this device. Although affordable, there does not appear to be any feedback mechanism with this tool.
Methods or systems of providing resistance exercise vary. U.S. Pat. No. 8,425,385 B2 Resistance Therapy describes utilizing fluid contained bladders that communicate with each other so that compression of one bladder causes the fluid to be transferred to a neighboring bladder. This system is adjustable to provide different workout levels and uses both bladders for working complementary muscle groups. Resistance could be adjusted by the thickness of the bladder, by valve, by size of the bladders and by viscosity of the fluids. However, this system does not use indicators, graduations, or any feedback mechanism. Nor does this method use floating devices to increase or decrease the resistance of the exercise by increasing the weight or length of items in the fluid within the bladders.
The present invention, Tongue Press Oral Exerciser was developed out of response to a need for an affordable tool for speech therapy patients to use at home. Equally as important, the device was designed to provide an exercise that would compliment the goals of care and subsequently increase the speed of recovery. As important as affordability, the device was purposely constructed to be simple to operate by patients of all levels of ability. The exerciser was developed to be capable of providing visual feedback, varying levels of difficulty, specificity of activity and isotonic/isokinetic exercise. Lastly, the present invention was engineered to be easily manufactured to insure commercial availability to patients in need of improved swallowing and speech.